Welcome to our new researcher – Abi Merriel

Ammalife is delighted to welcome Abi Merriel to Birmingham where she’ll work with Prof Arri Coomarasamy and the rest of the team to investigate the barriers to implementing good practice in low income countries. Abi is pictured (left) with Amie Wilson, Ammalife’s first researcher. Amie’s work on Traditional Birth Attendants, Clinical Officers and Caesarian Section outcomes, and transport problems facing pregnant women contributed to Ammalife’s work to improve the situation for many mothers whose pregnancies are overshadowed by the fear of death. Abi will be developing Ammalife’s research which is dedicated to finding practical and sustainable solutions to the difficulties facing many mothers.

Abi worked in Bristol before coming to Birmingham and she was part of the team that partnered with Mpilo Central Hospital in Zimbabwe to develop training for all staff dealing with obstetric emergencies. Here’s a Q&A from Abi explaining the project:

How did the partnership begin?

We established PROMPT (Practical Obstetric Multi-Professional Training) at Southmead Hospital in Bristol. Thabani Sibanda, an Obstetrician who had previously worked at Mpilo Central Hospital in Bulawayo, Zimbabwe, was one of the founders of PROMPT. Thabani realized that there were many similarities between Southmead and Mpilo and the two hospitals formed a partnership in 2011. One of the aims of the health partnership was to establish PROMPT training at Mpilo.

The project has also been supported by many members of the Zimbabwean diaspora with the help of Zimbabwe Health Training Support (ZHTS).

How did you set about the work in Zimbabwe?

In November 2011 we held a three-day PROMPT train-the-trainers course at Mpilo Hospital. Two midwives, two obstetricians, an anaesthetist and a paediatrician from the UK, three of whom had previously worked at Mpilo, helped to run the course. Afterwards, staff from Mpilo were able to run their own PROMPT courses at Mpilo Hospital for their colleagues. Since 2011, Mpilo staff have run 9 PROMPT course and have trained 229 members of staff. Two midwives and two junior obstetricians from Mpilo visited Southmead Hospital in September 2012 as part of the partnership.

Staff at Mpilo decided to trial the use of maternity early warning score charts (MOEWS). Southmead uses MOEWS charts to identify and treat unwell women. The Mpilo team adapted the Southmead MOEWS chart for their own hospital. They printed 2000 MOEWS charts in Bulawayo and the Mpilo PROMPT course included guidance on using them in the hospital’s Maternity Unit. Spot check audits monitored how unwell women were identified and treated before and after the introduction of the MOEWS charts. Staff completed questionnaires on the MOEWS charts and, following feedback, the MOEWS charts were revised. 5,000 charts were used.

What did you find?

The teamwork between midwives and doctors has significantly improved. Following the PROMPT courses there have been many changes in the maternity unit at Mpilo including the use of emergency boxes, a labour ward board, and MOEWS charts. Staff monitor clinical outcomes through the use of a maternity dashboard and they have organised training to address areas of concern.

Why is this important?

To provide safe maternity care takes more than more than knowledge and skills; it requires teamwork and systems to support evidence based care. PROMPT at Mpilo enables staff to train their own colleagues within their own hospital, helping them to learn how to manage emergencies where they happen in real life. Local training has helped staff find local solutions to their problems and improved team working.